Monday, August 11, 2014

New Drug Could Treat Low Testosterone with Fewer Side Effects

A new drug, enclomiphene citrate, may prove to be more effective in treating men with low testosterone than the testosterone gels and injections currently prescribed.

A similar drug has been used in fertility treatment to help women ovulate. Enclomiphene citrate is a derivative of clomiphene citrate, which is marketed under the name Clomid as a female infertility treatment. Researchers from Repros Therapeutics in The Woodlands, Texas, and from Baylor College of Medicine in Houston treated 73 men with “secondary hypogonadism.”

Researchers say the drug increased levels of testosterone produced by the testes, as well as levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produced by the pituitary gland. The study will appear in an upcoming issue of the journal Fertility and Sterility.

One side effect of current “low T” therapy is that testosterone gels and injections actually lower sperm count. This is because the influx of exogenous testosterone causes the brain to tell the testicles to produce less testosterone, which compromises sperm production. Many primary care physicians do not know about this effect, however, and they readily prescribe testosterone to male patients who have low testosterone and also wish to have a child, said Dr. Lawrence Ross, a urologist and professor emeritus at the University of Illinois at Chicago. He wrote an editorial accompanying the new study. A survey by the American Urological Association found that 25% of urologists said they would use testosterone to treat infertile men pursuing pregnancy.

Enclomiphene citrate doesn’t lower sperm counts because testosterone production in the testicles is not compromised. Clomid can actually produce similar results and physicians have been prescribing it “off label” to treat male infertility. However, the results have been inconsistent and many physicians are wary of its use in men.

Ross, in the editorial, noted that enclomiphene citrate or its broader family, called selective estrogen receptor modulators has the potential to help men who have postponed fatherhood into their 40s or 50s and now suffer from low testosterone.

MY TAKE:
That any physician is not aware that supplementing hormones decreases the body’s own hormone production is disconcerting. I am currently treating a couple in their early 30’s that have been unable to conceive. He has low testosterone and the fertility specialist prescribed testosterone shots. The couple, without any medical background, questioned the therapy and sought my advice as a result.

Testosterone use has skyrocketed in the past ten years as has male sexual dysfunction. Currently, over 50% of males over the age of 40 have some form of impotence. However, from my clinical experience, men are more interested in the body building benefits of testosterone. I recently had a male patient in his 40s that was considering stopping or at least reducing his testosterone use so he might be able to impregnate his new wife.

The brain has selective hormonal receptor sites to monitor production of the various hormones. When testosterone rises in the blood stream, it binds to the receptor sites. The brain then tells the testicles to slow testosterone production down. When testosterone levels fall in the blood, the receptor sites release the testosterone and the brain tells the testicles to increase production. Exogenous testosterone fills those sites and shuts down testicular function.

THE BOTTOM LINE:
This new drug is a step in the right direction. However, we already have an herb called Tribulus. It binds to open receptor sites in the brain and stimulates increased hormone production rather than a decrease. It is self regulating because the sites are only open when hormone levels are low. Research has shown Tribulus to be extremely effective in treating “secondary hypogonadism” and clinically I have been able to duplicate those results as well.

About Me

Dr. Longstreth holds level II certification in Quintessential Application (QA), a form of Applied Kinesiology (AK). He practices clinical nutrition and chiropractic using the QA format for evaluation and treatment. QA is a stepwise flow chart that evaluates and corrects, in order - neurological status, inflammation, immune response, endocrine balance, liver function, pancreas function, and finally structural integrity. Laboratory testing and imaging studies are used as confirmatory tests and to monitor progress. He has been in practice in Deerfield Beach, Florida since 1976.